WHAT WOULD OTHERS SAY ABOUT YOU?

Please provide information for 3 people whom we can contact for references.

PERSONAL REFERENCE #1: Name:

Reference Address 1:

City, State, Zip 1:

Phone: (include area code)

Occupation 1:

PERSONAL REFERENCE #2: Name:

Reference Address 2:

City, State, Zip 2:

Phone: (include area code)

Occupation 2:

PERSONAL REFERENCE #3: Name:

Reference Address 3:

City, State, Zip 3:

Phone: (include area code)

Occupation 3:

MORE ABOUT YOU:

TELL US ABOUT A TIME THAT YOU PERSONALLY GAVE GREAT CUSTOMER SERVICE:

WHY DO YOU WANT TO WORK FOR US?

WHY SHOULD WE HIRE YOU?

Have you ever been convicted of a felony?:YesNo

Do you have reliable transportation?:YesNo

I declare, under penalty of perjury, that I personally completed the application and that to the best of my knowledge the information provided above is accurate. I understand that any false information or significant omissions may disqualify me from consideration of emplyment. If chosen for employment, I will abide by and comply with all rules of the company. I further understand that I or the company may terminate my employment at any time without cause or notice and this agreement cannot be altered or modified.

Please Initial:

Date:

AN EQUAL OPPORTUNITY EMPLOYER

In compliance with the Civil Rights Act, the policy of this company prohibits discrimination in employment because of race, color, religion, national origin, veteran status, sex, age or handicap/disability. Please verify your understanding of the following statements by placing your initials below.